Plantar fasciitis, sometimes known as Policeman’s heel, is a very common condition affecting the foot, heel, and ankle. While plantar fasciitis can occur in the absence of any known acute injury, many people develop some form of this condition after recovering from an ankle sprain, which can prolong their return to pain-free activity.
This article will discuss why plantar fasciitis can occur after ankle sprains, simple strategies to minimize the risk of developing this type of foot and heel pain, and how you can actively treat it if it already has developed.
What is Plantar Fasciitis?
Plantar fasciitis refers to inflammation, irritation, and/or damage to the plantar fascia, which is a passive structure that provides support to the sole of the foot.
The plantar fascia runs from the bottom of the heel bone to the bottom of the forefoot. This structure is inherently tight in order to prevent the arch of the foot from collapsing or flattening out too much.
While it’s a very strong and robust structure, that fact that it’s a passive tissue means it cannot be actively contracted, and as such, is at the mercy of the forces placed upon it.
What causes plantar fasciitis?
Plantar fasciitis can develop with repetitive strain to the plantar fascia, or in other words, overuse. It can also develop when there is a sudden increase in activity that places excessive or frequent strain on the plantar fascia.
Essentially, this means anything that exceeds the plantar fascia’s load capacity can cause irritation or damage to the tissue, especially if this occurs in a repeated fashion with minimal recovery.
Weakness in muscles that help support the bottom of the foot can also create more dependence on the plantar fascia. If it has to take over for weak muscles, there is a higher chance that it can become inflamed, irritated, or damaged.
Plantar fasciitis is not the only potential source of foot and heel pain, but it’s by far the most common. While symptoms can lead to symptoms anywhere along the sole of the foot, the most common location is on the front of the heel bone just towards the inside (anteromedial aspect of the calcaneus).
Feel free to check out one of our other articles about other sources of heel pain after ankle sprains.
Risk Factors for Plantar Fasciitis
Additionally, there are some risk factors that make people more susceptible to developing plantar fasciitis (Goff et al 2011, Schwartz and Su 2014). These include, but are not limited to, the following:
- Excessive foot pronation (pes planus) or a very high arch (pes cavus)
- Excessive running
- Leg length discrepancy
- Occupations involving prolonged standing or walking
- Tight Achilles tendon and/or reduced ankle dorsiflexion
- Weak plantarflexion
- Weak or tight intrinsic muscles of the foot
- Sedentary lifestyle
- Poor footwear
Why can you get plantar fasciitis after a sprained ankle?
Considering the risk factors listed above, a sprained ankle may put you in a situation where you now have some of those risk factors, meaning you may be more prone to developing foot and heel pain in general, but especially after ankle sprains.
For example, a sprained ankle can often lead to generalized joint stiffness from swelling and inflammation, as well as potentially being immobilized for a while. Specifically, if ankle dorsiflexion is reduced, which it almost always is after a sprained ankle, then you now have a risk factor for plantar fasciitis.
Additionally, by resting and protecting the ankle in the acute stages of injury, it can be expected that there will be some muscular deconditioning, specifically when it comes to the intrinsic muscles of the foot, as well as other muscles that support the ankle joint and provide power during walking, namely the calf muscles.
In this case of more severe ankle sprains, there may be a period where you are non-weight bearing altogether. Those who return to weight bearing activities without proper strengthening and stretching of the foot and ankle muscles will also be at higher risk of developing plantar fasciitis after an ankle sprain.
How can you prevent and treat plantar fasciitis after a sprained ankle?
The best thing you can do to prevent the development of plantar fasciitis while recovering from an ankle sprain is to seek advice from a physical therapist, which will allow you to address any acute pain happening from this injury, and minimize the chances of developing chronic pain in the foot and ankle region.
We will outline some of the general strategies below, each of which can help prevent or treat plantar fasciitis, but please keep in mind that the time point in which you initiate these exercises may vary on an individual basis, which is why we highly recommend attending physical therapy for your specific injury.
Foot Intrinsic Strengthening
The foot intrinsic muscle are the smaller muscles in the foot that span a single joint or small area of the foot. They are highly active in weight bearing, especially while walking or running, and as such, they help provide the foot and ankle with the necessary stability.
In this case, it’s important to include at least one or two very simple exercises to keep the foot intrinsic muscles strong. This will help reduce ankle pain and heel pain after a sprain, and will minimize the chances of developing plantar fasciitis symptoms. The exercises may include:
Towel Scrunches: Put a towel on the floor and progressively pull it in towards you without lifting your heel off the floor.
Short Foot Doming: Contract the muscles on the inside portion of the bottom of your foot as if you’re trying to “tent” the medial arch. Some people find it helpful to think about pulling the ball of their big toe towards their heel. There will be minimal movement in the foot, so it can be a little tricky at first. This can be done in sitting, progressing to standing, and then practicing this while accepting weight during walking.
Rolling the Plantar Fascia
Rolling the plantar fascia is a very convenient way to maintain mobility in the region while also providing temporary relief if you are already experiencing symptoms. In this case, you can use any form of ball (e.g. tennis ball, golf ball, lacrosse ball, or even a specific plantar fascia ball).
Some people also really enjoy using a frozen water bottle. This may not lead to a permanent long-lasting solution, but can definitely help provide temporary relief from heel pain caused by plantar fasciitis.
As an added benefit, some research shows that rolling the plantar fascia in the presence of ankle instability can also help with balance (Helly et al, 2020), which makes it a good exercise selection while rehabbing ankle sprains.
Stretching the Plantar Fascia
Stretching the plantar fascia is also a nice way to maintain soft tissue flexibility in the region, especially if you’re not able to be on your feet as much. This can be done in different ways, but the general concept is to place your ankle in a dorsiflexed position while also extending your big toe. This is sometimes known as a Windlass stretch.
Windlass Stretch: You can do this stretch in a sitting position. In this case, bring your foot up to your opposite lap and use your hands to stretch into ankle dorsiflexion and big toe extension.
You can also do this stretch in a standing position. In this case, perform a usual calf stretch by having your leg extended behind you with your heel and foot flat on the floor, but add a rolled-up cloth or some form of wedge under your big toe so that it is placed in an extended position.
As stated above, reduced ankle dorsiflexion is a risk factor for developing plantar fasciitis, and this stretch is safe for most forms of ankle sprains, so it can be a really nice one to incorporate, especially if you have a history of tight calf muscles.
If you have a high ankle sprain, or a complex ankle injury, consult with your physical therapist prior to performing this stretch, as these types of ankle injuries may need a little more time for recovery at first before beginning this stretch.
Calf Stretching and Ankle Dorsiflexion Mobility
In addition to the plantar fascia stretch above, simply making sure to prioritize calf flexibility and ankle dorsiflexion mobility is important for rehabbing any ankle sprain, but will also help minimize the risk of developing plantar fasciitis after an ankle sprain, as well as other conditions that may lead to ankle pain and heel pain, such as tendinopathies.
A couple additional ideas include a standing gastrocnemius stretch (same as above, just without the toe lift), a standing soleus stretch, and ankle dorsiflexion passive range of motion (PROM).
Standing Soleus Stretch: This is the same as a normal calf stretch, but involves keeping the knee in a slightly bent position. This will put the gastrocnemius muscle on slack, which shifts the focus on the stretch to the soleus muscle.
Ankle Dorsiflexion PROM: This is often performed in a 1/2 kneel position, which is the position of “taking a knee”. Place the injured foot in front of you flat on the ground and lean forwards while you keep your foot flat on the ground. This will bring you into an dorsiflexed position, and you may feel restriction on back of the ankle in the Achilles tendon, or in the front of the ankle at the joint line.
It is important to perform these exercises within tolerance, meaning you aren’t pushing through pain and further irritating the foot and ankle. For these exercises, it’s more about frequently chipping away at the motion making consistent small gains in mobility, as opposed to pushing through pain in attempt to get it all back at once.
Calf strengthening is important to ensure adequate support around the ankle, especially considering the calf muscles are highly involved in any form of activity involving walking, running, or jumping.
Calf raises are the simplest way to strengthen the calf muscles. In this case, there are a couple different ways of doing it.
Gastrocnemius Calf Raise: This will involve lifting your heels off the ground like you are standing on your toes. You should feel your calf muscles contract while you perform this exercise. To target the gastrocnemius muscle, make sure you are keeping your knee as straight as you can while performing this exercise.
To progress your calf raise, you can perform it on the edge of a step, which increases the amount of motion, and this will also allow you to stretch the calf muscles at the same time. You can also go from double leg to single leg, or add resistance by wearing a backpack or holding a dumbbell.
Soleus Calf Raise: To target the soleus muscle, simply perform the same exercise as above, but maintain a slight bend in the knee. This will reduce the ability of the gastrocnemius to generate this motion, placing more reliance on the soleus muscle.
Tibialis Posterior Strengthening
Tibialis posteror is a muscle that sits deep to the calf muscle complex. It is often considered the core of the lower leg. This muscle performs similar actions as the calf muscle, but can also perform ankle inversion.
Moreover, given the path of this muscle and the site of its tendon insertion, it provides a significant amount of support for the medial arch of the foot and sole of the foot in general. Therefore, the tibialis posterior muscle directly supports the plantar fascia.
Both ankle plantarflexion and ankle inversion will recruit this muscle, but combining them can be even more effective. This is a muscle that is often targeted to prevent and/or treat medial ankle sprains, but should really be included for any ankle injury.
Ankle Inversion with a Resistance Band: This can be done by tying a resistance band around your mid-foot and tying it off to a table leg. Move your ankle inwards against the resistance of the band.
Double Leg Tibialis Posterior Calf Raise: To place an emphasis on the tibialis posterior muscle while performing a calf raise, simply squeeze a tennis ball or rolled-up cloth between your ankle while performing the calf raise.
Single Leg Tibialis Posterior Calf Raise: For a more advanced calf raise that targets tibialis posterior, lean into a wall so your hip is in slight abduction and your ankle is in an inverted position. Lift your heel off the ground straight up into the air (i.e. not pushing into the wall). This position will help you target the tibialis posterior muscle.
Flexor Hallucis Longus Strengthening
The flexor hallucis longus muscle is another muscle that sits deep to the calf. Its tendon follows a similar path to the tibialis posterior tendon, wrapping around the inside of the ankle and ultimately attaching to the bottom of the big toe.
While this muscle isn’t overly powerful, it does assist in providing dynamic support to the bottom of the foot, and as such, can help support the plantar fascia.
Toe Flexion with a Resistance Band: To strengthen this muscle in a more isolated fashion, you can wrap a resistance band around your big toe and bend the big toe down against the band. The set up is a little awkward, but the nice part of this exercise is that it’s easy to do if you’re sitting and watching TV.
Finally, the peroneal muscles are crucial for general ankle stability and preventing recurrence of inversion ankle sprains. Given this is one of the most common early stage ankle rehab exercises you may see in physical therapy settings for lateral ankle sprains, you may be familiar with it if you have a history of sprains.
Even though it’s introduced early on, it can be helpful throughout the entire course of rehab, and given this helps a lot with improving ankle stability, it will certainly assist with rehabbing ankle pain and heel pain associated with plantar fasciitis.
There are three peroneal muscles that all help with ankle stability, but peroneus longus has an additional role with foot support, as it passes from the outside of the ankle, underneath the sole of the foot, and inserts on the bottom and inside of the forefoot.
Ankle Eversion with a Resistance Band: This can be done by tying a resistance band around your mid-foot and tying it off to a table leg. Move your ankle outwards against the resistance of the band. You should feel the muscles on the outside of your leg contract with this exercise.
Peroneus Longus and Flexor Hallucis Longus Squat: To incorporate activation of these muscles into a functional movement pattern, simply tie a resistance band to something in front of you close to the floor. Pin the band down with the ball of your big toe (but NOT your heel!) and make sure there is a good amount of tension on the band. Perform squats with equal weight distribution between each leg and don’t let the band fly out from under your toe.
Plantar fasciitis is an extremely common condition causing heel pain and pain in the sole of the foot. It can occur without any acute injury, but many people find they experience some element of plantar fasciitis after an ankle sprain.
The strategies listed above are meant to serve as a guide for things that can help resolve plantar fasciitis after an ankle sprain. When in doubt, we highly recommend consulting with a physical therapist to identify the best strategies for your particular needs.
Goff, J. D., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. American family physician, 84(6), 676-682.
Helly, K. L., Bain, K. A., Gribble, P. A., & Hoch, M. C. (2020). The effect of plantar massage on static postural control in patients with chronic ankle instability: a critically appraised topic. Journal of Sport Rehabilitation, 30(3), 507-511.
Schwartz, E. N., & Su, J. (2014). Plantar fasciitis: a concise review. The Permanente Journal, 18(1), e105.
The content here is designed for information & education purposes only and is not intended for medical advice.